Observation On Outcomes Of Short-Segment And Long-Segment Instrumental Fusion For Degenerative Lumbar Scoliosis

Objective:To evaluate and compare the clinical and radiographic outcomes of short-segment fusion and long-segment instrumental fusion for degenerative lumbar scoliosis.Methods:Retrospectively collect and analysis the clinical data of28patients,who were diagnosed DLS and treated by posterior decompression and instrumental fusion in Qilu Hospital during2011.8to2013.1. According to the range of fusion,these patients were divided to two group:A group(17cases),the short fusion group; B group(11cases),the long fusion group. The scoliosis Cobb’s angles and lumbar lordosis angles were measured preoperatively and at final follow-up,so were the JOA low back pain scores. Compare the preoperative and final follow-up data of each group to evaluate the the clinical and radiographic outcomes of each group,and compare the recovery rate of the Cobb’s angles,lumbar lordosis angles and JOA scores of each group to compare the outcomes of each group.Results:The number of instrumental segment was2.8±0.9in A group and5.7±1.5in B group with a statistical difference(P<0.01).The preoperative Cobb’s angles.lumbar lordosis angles and JOA score was17.7±2.7°,24.2±2.9°and15.4±2.2in A group.The final Cobb’s angles,lumbar lordosis angles and JOA score was8.3±1.2°,31.1±3.2°and23.1±1.4in A group. There was a significant difference(P<0.01).The preoperative Cobb’s angles,lumbar lordosis angles and JOA score was27.8±3.6°.21.8±2.3°and14.1±1.7in B group.The final Cobb’s angles,lumbar lordosis angles and JOA score was9.7±2.4°,28.3±3.1°and22.2±1.1in B group. There was a significant difference(P<0.01). The recovery rate of the Cobb’s angles of the two group had asignicant diffference(P<0.01), but the recovery rate of the lordosis angles and JOA scores of the two group had no significant difference(P=O.44>0.05, P=401>0.05).Conclusion:1.The posterior decompression and instrumental fusion is a effective therapy for degenerative lumbar scoliosis2.The long-segment instrumental fusion changes the scoliosis Cobb’s angle better, but has no significant difference in changing the lumbar lordosis angles and JOA scores compared to the short-segment instrumental fusion3.When the Cobb’s angle<20,the lumbar lordosis angle loss is small,it’s better to choose the short-segment instrumental fusion; When the Cobb’s angle>20°,the lumbar lordosis angle loss is big,it’s better to choose the long-segment instrumental fusion.4.The long-segment instrumental fusion surgery always has more blood loss and longer operation time,which increases the risk of surgery,we should choose the long fusion carefully according to the indications.